The occurrence of hypertension (elevated blood pressure) in the elderly is high. This is also the age group with a high incidence of arthritis. Osteo-arthritis is common after the age of 40. The presence of an inflammatory component to osteo-arthritis is now recognized. About 30% of patients with arthritis also have hypertension. Thus there is a considerable potential for the concurrent prescription of non-steroidal anti-inflammatory drugs (NSAIDs) and anti-hypertensives in the elderly population group. It is estimated that, in the United States, more than 20 million people are on concurrent anti-hypertensive and NSAID therapy. It is known that most anti-hypertensive agents are less effective in the presence of NSAIDs.
In the past several years, there have been various reports of adverse effects of NSAIDs in patients receiving any form of anti-hypertensive medication such as .beta.-blockers, angiotensin converting enzyme inhibitors and diuretics. The hypotensive (blood pressure lowering) effect of .beta.-blockers is attenuated by the combined administration of NSAIDs such as indomethacin, sulindac and piroxicam. Significant attenuation of the hypotensive effect of the angiotensin-converting enzyme inhibitor captopril by indomethacin, acetylsalicylate and sulindac has been reported. The antagonism by NSAIDs of the hypotensive effects of diuretics such as furosemide and hydrochlorothiazide has also been reported. Naproxen and piroxicam have been reported to raise blood pressure of patients significantly during the concomitant use of drugs such as .beta.-blockers and diuretics. Most NSAIDs appear to reduce the anti-hypertensive effect of a variety of anti-hypertensive drugs, with the exception of the calcium channel blockers, which in any event have recently been reported to have other adverse side effects. Patients with renal impairment are at a risk of developing renal side effects when NSAIDs are used. In the elderly population suffering from various arthritic disorders, the potential adverse interaction between anti-inflammatory and anti-hypertensive drugs poses a significant problem. Treatments that maintain the anti-hypertensive action would be very beneficial to this age group.